The Value of Specialized Care for Diabetes in Pregnancy

Diabetes in pregnancy carries extra risks for mom and baby. That’s why UChicago Medicine has a specialized program to provide expert care.

For many women, pregnancy can be a time to reconnect with their bodies and focus on creating a healthy environment for their baby to develop and grow. This is especially important if a woman has Type 1 or Type 2 diabetes or is at risk of developing gestational diabetes during pregnancy. To provide specialized support, the University of Chicago Medicine has launched a new Diabetes in Pregnancy Program at UChicago Medicine Duchossois Center for Advanced Medicine in Hyde Park.

“This is a program we started 18 months ago to bring together experts as a multidisciplinary team with an interest and passion for the special needs of pregnant women with diabetes,” explains Laura Dickens, M.D., endocrinologist and co-director of the Diabetes in Pregnancy Program. “We all want to give women access to experts and the ability to have their care in one physical space.”

Dr. Dickens is joined by Maritza Gonzalez, M.D. — co-director of the Diabetes in Pregnancy Program, obstetrician and maternal fetal medicine physician — as well as physician assistants, certified diabetes educators, registered nutritionists and sonologists who specialize in high-risk pregnancies.

The use of the latest technologies is a big component of this program and the team closely monitors mothers for hypertensive disorders and babies for abnormal heart rates, cardiac malformations and neural tube defects, which are all risks that can occur when blood sugar is uncontrolled. Because the team members know about the latest technologies in the field of diabetes, they’re able to help women with continuous glucose monitors and insulin pumps, which help women check their blood sugar and receive insulin more conveniently.

“The major benefit of our program is that it’s a great gateway to better long-term care for the women we work with,” says Dr. Dickens. “Diabetes is really a public health issue, and women who have gestational diabetes have up to a 50% lifetime risk of developing Type 2 diabetes. So, after their baby is born we want to provide the appropriate screening and help women understand the risks to their long term health and steps they can take to decrease that risk.” Intensive lifestyle changes can cut that risk of Type 2 diabetes substantially, she says.

Individualized care means each patient can receive a blend of care from a regular OB while benefitting from specialized support from the Diabetes in Pregnancy team — even through telehealth when necessary.

The team focuses on a bigger picture of a healthier population, too. “We have a big training and education component and our patients benefit from that as well,” Dr. Dickens adds.

Expert support, even before pregnancy

Visits to the Diabetes in Pregnancy Program prior to conceiving provide an ideal opportunity for women to prepare for a healthy pregnancy. The truth is that all pregnancies are at risk for gestational diabetes — and children of women with gestational diabetes have a higher risk of Type 2 diabetes.

“A pregnancy with diabetes has a significantly higher risk of multiple complications, including miscarriage, preterm delivery, complications at delivery and long-term health implications,” Dr. Gonzalez says, adding that risks can be decreased through being proactive. Positive changes can help the whole family.

“If you are in the planning stage of your pregnancy, you can gain education on diet and recommended glucose control, which is great because your risk is modifiable,” she says. “If you have gestational diabetes during your pregnancy, we want you to know that this increases your risk of diabetes later in life. So much of the treatment for diabetes in pregnancy is diet and exercise — it is straight forward but that’s a hard thing to do.”

The UChicago Medicine Diabetes in Pregnancy Program also works to reduce the stigma of diabetes and encourage women to be proactive and not avoid seeking support because they are afraid of a diagnosis. It’s better to know your risks so you can take action, says Dr. Dickens.

“We want everyone to recognize how common it is, and that everyone is at risk. You are not alone,” she says. “We empower women to plan ahead. If you have diabetes, talk with your care team and modify your risks to have a healthy pregnancy. Diabetes can be a warning signal to make healthy changes through activity, diet and moderating weight. It’s following a healthy lifestyle we should really all have, but especially new and expectant moms.”

Convenience and best-in-class care

Knowing that the women they serve often have many responsibilities at home or work, the Diabetes in Pregnancy team is committed to decreasing obstacles for the very best care by bringing all of the services they need into one physical location, says Dr. Gonzalez.

“Preexisting diabetes and pregnancy or gestational diabetes make the pregnancy more labor-intensive for a woman and more of a challenge to manage their resources and their family, so we wanted to provide one physical space for them to visit,” Dr. Gonzalez says. “When issues come up that complicate their care or something urgent happens, it’s easier to have their care in one place.”

As an aside, UChicago Medicine is known worldwide for research into rare forms of diabetes, including monogenetic diabetes and maturity onset diabetes of the young. “UChicago has a registry where we study patients with these rare genetic types of diabetes,” says Dr. Dickens. With this level of expertise, it makes sense to trust your diabetes in pregnancy care to a highly regarded research organization.

Some tips for a healthy pregnancy

Rates of gestational diabetes mirror the rates of obesity in the U.S., so many women could be at risk and not be aware, says Dr. Gonzalez. Regardless of your history with diabetes, if you are obese or have previously given birth to a baby 9 pounds or more, the experts recommend getting tested for diabetes early in your pregnancy. “You may need additional screening, but the best part of all of this is it’s modifiable. It might not be easy, but it is modifiable,” she adds.

Dr. Dickens offers these suggestions for everyone — pregnant or not — for better health and lower diabetes risk:

  • Eating sweets doesn’t cause diabetes, but for someone at risk, sweets can increase blood sugar. Best way to avoid extra sugar in your diet? “Avoid sugary drinks,” Dr. Dickens says. “Juice and soda do not have nutritional value and drinking them can become a habit, and then pretty soon your children are drinking them, too.”
  • Carbohydrates are not the enemy, but choose whole grains and other complex carbohydrates. Enjoy a diet of lean proteins and lots of vegetables.
  • “Moderate-intensity exercise really does make a difference,” she says. Aim for 30 minutes, five times a week. “This doesn’t have to be at the gym. It can be a walk to the playground or through the park, even climbing the stairs.”

Dr. Gonzalez agrees. “Some of us have the idea that exercise is too hard to do. But it doesn’t have to be CrossFit. Dance to a favorite song after a meal, or take a walk. Break your exercise up into smaller segments. It’s a lot easier than we think it is and it’s so beneficial,” she says. “You will feel so much better.”

Learn more about the Diabetes in Pregnancy Program at UChicago Medicine Duchossois Center for Advanced Medicine in Hyde Park. Visit uchicagomedicine.org.

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